Am experimental treatment may eventually change the lives of children affected by a peanut allergy.
Rocio Miscio's daughter, Violet, is severely allergic to peanuts. A family history of allergies and asthma meant that she wasn't supposed to eat peanuts until she turned two — but when she got into a jar of peanuts when she was just a year old, her parents realized she had a severe allergy.
"She got one, put it in her mouth and spit it out. And just broke out. Her lips and eyes swelled up," said Miscio. "It was very scary."
By the time Miscio raced home from her job, her mother, who was watching the little girl, had given her Benadryl.
"Knowing what I know now, I would've rushed her to the ER, but I didn't expect that as a brand new mom," said Miscio.
The Benadryl worked to quell the reaction, but a follow-up test revealed Violet's allergy was severe and would lead to what Miscio called "nine years of constant vigilance, all the time."
For years, everything was a potential danger, and there were scary reminders of how dangerous the allergy was.
"As cautious as we were, I know my husband ate a peanut candy at work and then came home and gave her a kiss on the cheek," Miscio said. "She broke out in welts, hives, on her cheek."
For a long time, Miscio was scared to leave Violet anywhere, whether it was school or dance class or a birthday party. She remembered waiting in the car in case of potential tragedy, carefully monitoring restaurants. They avoided airplane trips to see family members who lived across the country.
"It impacts in so many different ways," Miscio explained. "It kinda ripples. It's not just living with the allergen, it's the impact it has on a family.
The allergy took a severe toll on everybody — so when Miscio heard about a potential "cure" for peanut allergies, she knew she had to look into it. After six years on a wait list, Violet was enrolled in an oral immunotherapy clinical trial, which Miscio heard about through Dr. Kari Nadeau, director of the Sean Parker Center for Allergy and Asthma Research at Stanford.
I can just go in a door without having to wipe it down. I can sit at tables.
Allergies are increasing around the world, said Nadeau. It's unclear why rates are increasing, but the rise has motivated doctors to start looking into potential solutions.
"In 2003 there were no companies trying to get a product out to be approved for food allergy therapy. And now there are 17," Nadeau said. "And over the last couple years, the FDA has been very promotional in support of fast-track designation. The FDA is allowing us to move forward to get some drugs approved."
Researchers first tested what level of exposure caused Violet to have an allergic reaction. The number varies for everyone.
For Violet, it took as little as 1/80th of a peanut to trigger a reaction. The treatment works to slowly increase that amount.
"Maybe before you could react to a speck of peanut flour," explained Nadeau. "By every day training your immune system to build its strength, you increase the threshold." "
Nadeau said that the results of the trials seem to be very positive so far, estimating that 67% to 80% of patients were able to tolerate a peanut or more after completing the treatment. Even more amazingly, a skin patch version of the trial showed good results as well, showing that some patients may not even need to eat a peanut to get the results.
While the process was scary, including exposure therapy and intentionally induced anaphylaxis, Miscio said it was entirely worth the results: the trial was a success for Violet.
Violet still has to be careful about eating peanuts — she eats two a night to maintain her tolerance, but more than four will inflame her allergies — that tolerance makes it much easier for her to go about daily life.
"Now, I don't have to wipe everything down," said Violet, who's currently in sixth grade. "I can just go in a door without having to wipe it down. I can sit at tables. I can eat at restaurants and fly on planes."
The treatment has made a huge difference to the family's lifestyle.
"The joy from seeing her live life like we did as kids is amazing," said Miscio. "So it's been tremendous."
Other treatments are in the works as well. Some therapies are being designed that will block the allergic pathways, preventing reactions from ever happening.
Nadeau said that she's even optimistic about the potential future for an allergy vaccine. She also said that doctors are looking to expand treatments to cover more allergens, such as other tree nuts, milk, and eggs.